21 Fr./7-mm PRINCESS^™ Resectoscope

A member of the Reviews in Obstetrics & Gynecology editorial board reviewed the following devices. The views of the author are personal opinions and do not necessarily represent the views of Reviews in Obstetrics & Gynecology or MedReviews®, LLC. Companies can submit a product for review by e-mailing Merilee Croft at mcroft@medreviews.com.

• Design/Functionality Scale

  • 1 = Poor design; many deficits

  • 2 = Solid design; many deficits

  • 3 = Good design; few flaws

  • 4 = Excellent design; few flaws

  • 5 = Excellent design; flaws not apparent

• Innovation Scale

  • 1 = Nothing new

  • 2 = Small twist on standard technology

  • 3 = Major twist on standard technology

  • 4 = Significant new technology

  • 5 = Game changer

• Value Scale

  • 1 = Added cost with limited benefit

  • 2 = Added cost with some benefit

  • 3 = Added cost but significant benefit

  • 4 = Marginal added cost but significant benefit

  • 5 = Significant cost savings

• Overall Scale

  • 1 = Don’t bother

  • 2 = Niche product

  • 3 = Worth a try

  • 4 = Must try

  • 5 = Must have

Design/Functionality: 4.5

Innovation: 5.0

Value: 3.5

Overall Score: 4.5

Background

Resectoscopy is a mainstay of the surgical treatment of submucous myomas. Although generally safe procedures, hysteroscopies using monopolar resectoscopes have been associated with complications related to the use of distention media such as 1.5% glycine, sorbitol, mannitol, and dextran. Specifically, excessive absorptions of these hypotonic distention media can lead to life-threatening hyponatremia, hypokalemia, hypocalcemia, and hypoosmolarity. ¹ Switching from monopolar to bipolar resectoscopes eliminates the need for hypotonic distention media and allows surgeons to use good ol’saline. Unfortunately, until relatively recently this was not an option in resectoscopy. A few years back, Richard Wolf Medical Instruments Corporation (Vernon, IL) introduced the first bipolar resectoscope with its Bipolar Chip E-Vac system,² and now the same company brings us a newer, slimmer version with its 21 Fr. / 7-mm PRINCESS^™ Resectoscope.

Design/Functionality

With its beginnings in Berlin, Germany, in 1906, the Richard Wolf corporation has a long and distinguished reputation in the endoscopy world and, as a rule, produces high-quality instruments. The PRINCESS resectoscope is no exception. First, at 21 Fr. / 7-mm, it is the smallest resectoscope available-and smaller diameter means easier insertion and less dilation. Yet, when coupled with the 12°; Panoview Plus endoscope, it does not yield any compromises with visualization as compared with its larger cousins. Second, its E-Line construction with its Qui-Connect locking mechanism allows for easy assembly and disassembly with a push-button release mechanism. Third, the S-Line feature allows the PRINCESS compatibility in bipolar mode as well as monopolar with only a change in the cable and solution (though why one would want to use it in a monopolar mode is unclear). Finally, the PRINCESS is unique in that the inner and outer sheaths can be changed from 21 Fr. to 24 Fr. while the working element remains the same. This allows the same system to be used for larger pathology if that is desired. Sadly, the rotatable feature is only available with the 24 Fr. sheaths-but that is something to look forward to in the future.

In use by the author, the PRINCESS performed with regal elegance. Sleek and quick to assemble, the scope goes in easily, provides a great picture, and cuts through pathology like a bipolar knife through butter.

Design/Functionality Score: 4.5

Innovation

Because nobody else has a similar product in this highly competitive market, I can only assume that the innovations required were substantial to create this thin-line, dual mode (bipolar and monopolar) resectoscope. Given the huge advantage of working without hypotonic distention media and the risks they bring, this innovation cannot be seen as anything less than a game-changer.

Innovation Score: 5.0

Value

Although the system works with most fluid management systems on the market, getting the PRINCESS does mean buying a whole new resectoscope system and chucking whatever you had before. Specifically, this entails buying the 12°; Panoview Plus endoscope ($3147.50), a 21 Fr. E-Line inner sheath ($639.50), a 21 Fr. E-Line outer sheath ($800), a 21Fr. working element ($1412.50), a 21 Fr. obturator ($120), and a bipolar cable ($247) for a total retail price of $6366.50. Of course, there is usually a trade-in discount or something similar, but moving to this system does require a significant capital cost. That said, $6366.50 is cheap money to rid your hospital of the scourge of glycine.

Value Score: 3.5

Summary

If you perform operative hysteroscopy then you have had a problem with excessive absorption of hypotonic media. Fortunately, for most of us, that problem has been the early termination of a procedure due to exceeding the protocol limits for glycine or something similar rather than a serious patient injury or death. Nonetheless, if you could have all the benefits of a resectoscope without the hassle of hypotonic media, wouldn’t that be great? If so, the PRINCESS is great.

Overall Score: 4.5

21 Fr. / 7-mm PRINCESS^™ Resectoscope (Richard Wolf Medical Instruments Corporation, Vernon, IL). Photo courtesy of Richard Wolf.